Sources of unreliability of DSM-III Axis IV.

Lists of stressors recorded for 159 adolescents and rated by two judges showed poor agreement on stressor identification but good concordance for the most severe stressor identified for each patient. Good agreement was also found for a short checklist of chronic stressors. When individual stressors were rated by four judges for 27 patients, global Axis IV ratings were largely determined by the rating of the most severe event. Those results suggest that Axis IV can be made more reliable and easier to use by concentrating on the identification of severe events.